Let alone a street, even if it is just a department, it is still very deep.
Wherever there are people, there are rivers and lakes. This is an eternal truth.
Li Jingsheng was able to integrate into this interest group and quickly obtain such a high status, which was both a matter of strength and luck.
The banquet ended and everyone dispersed.
There is a small detail that is particularly interesting. Boss Zhao has always been drooling over Tang Ping, but he did not say a word to her at the banquet and did not even dare to look at her.
I don’t know if it’s because the proprietress of Fredo’s Drug Store was present, and I was worried that she would be jealous and capsize.
Still worried about Li Jingsheng's strength and status.
In short, Boss Zhao is a smart man, and he is often very cautious about risky things.
Li Jingsheng drank a few glasses of wine and was slightly smoked. After returning to the clinic, his mind was clearer than ever.
Sitting in the empty reception hall, his mind was thinking about the difficult case that Director Mu encountered.
The patient is less than 40 years old and is a female patient. The occupation description in the medical record is agricultural plantation staff.
It is foreseeable that this patient's income should be relatively low and his education level should not be high.
Because under normal circumstances, most middle-aged people with a slightly higher education level will go to the city to work in order to increase their family income.
The patient developed pain in his right lower limb a month ago, decreased urine output, and significantly gained weight in his lower limbs.
Later, the doctor at the Second Hospital confirmed that it was not weight gain, but edema.
Oliguria, lower limb edema, and right lower limb pain, according to normal diagnostic thinking, first of all, there must be a problem with the kidneys.
In fact, the first number the patient registered was indeed the number from the Urology Department of the Second Hospital.
Maybe because of financial constraints, I was reluctant to register as a director, but instead registered as an ordinary outpatient clinic.
The doctor who treated her was Tan Shuilin, an outstanding young doctor from the Department of Urology of the Second Hospital.
This person is similar to Dr. Qin from the Orthopedic Surgery Department. They both belong to the better category of resident doctors.
Ordinary residents are not eligible to open outpatient clinic numbers.
For example, Li Jingsheng could only work under Dr. Xu when he first joined the Second Hospital. Until a few days ago, Dr. Xu asked him to "set up his own business" and treat patients separately from Dr. Xu.
The Orthopedic Surgery Department then came forward to help him apply for an outpatient physician number.
Even though it is just a very inconspicuous thing, for a doctor, it is a big step forward.
Many resident doctors are eager to endure it. Even if they only have the opportunity to sit in the outpatient clinic one day a week, they are happy and looking forward to it.
Because most doctors need to wait until they are attending to treat patients before they have the opportunity to open an outpatient clinic number and officially have the qualifications to treat patients.
Just like a doctor in ancient times, you need to be at least a medical doctor to be qualified to treat patients.
You must at least reach the level of an official to be considered a serious doctor.
This qualification requirement also exists in modern times. Under normal circumstances, a doctor needs to undergo a one-year internship to graduate, and then three years of training and obtain a medical certificate to become a formal resident physician.
If you want to be a doctor, you have to keep working hard. A master's degree requires more than two years of formal work before you can take the exam to treat.
Only when you are promoted to attending physician can you be considered 'like a doctor'.
After Tan Shuilin received this patient, he naturally carefully prescribed multiple examinations and conducted careful consultation.
For fear of misdiagnosis.
After careful examination, he found that the patient not only had edema in his lower limbs, but also found two abdominal masses, located on the left and right waist and abdomen respectively.
Kidney edema is generally unlikely to swell that much.
Realizing the seriousness of the problem, Dr. Tan Shuilin became more cautious.
After detailed questioning of the patient's symptoms, the patient reported that the pain started from the right waist and buttocks, like a pinprick, and extended to the back of the right thigh, all the way to the calf.
The patient also experienced a series of symptoms such as decreased urine output, abdominal distension, lower limb edema, dizziness, fatigue, nausea, and vomiting.
These symptoms vaguely point to severe kidney disease, such as uremia.
According to actual measurements, the patient's urine output that day was only about 500ml.
The patient's body temperature was 37.8 degrees and there was obvious low fever.
The blood pressure was 190mmhg systolic and 118mmhg diastolic.
Normal blood pressure for adults, systolic blood pressure is between 90-139mmHg, and diastolic blood pressure is between 60-89mmHg. This is the ideal blood pressure range.
This female patient obviously has high blood pressure.
Uremic patients will have high blood pressure and fever, and Dr. Tan further determined that the patient had renal failure combined with acute nephritis.
After abdominal ultrasound examination, it was found that the patient's kidneys were enlarged.
This also confirmed that the masses felt at both sides of the patient's abdomen were kidney enlargement.
The kidney is actually a bit like a sponge. Its internal structure is very complex. It mainly filters liquid through the glomerulus and excretes toxins and excess water into urine. What is useful is returned to the blood circulation.
This is why for some heart diseases, doctors will ask for urine tests and even kidney function tests.
It’s really not excessive medical treatment, but the doctor suspected that kidney disease caused heart disease.
Dr. Tan Shuilin prescribed routine blood and urine tests to the patient.
Hemoglobin 47g/l, white blood cell count 5.7 times ten to the ninth power per liter.
Lymphocytes are about 0.35.
Platelets89.
Urine protein quantification is 0.26g/day, which is a twenty-four-hour measurement.
The specific gravity of urine was 1.015, and the blood urea nitrogen was 14.7mmol/l.
After checking this, Dr. Tan Shuilin was confident that the patient had rapidly progressive nephritis, renal failure combined with polycystic kidney disease.
So he was admitted to the hospital and treated with diuresis, blood vessel dilation, infection and other measures.
It can be seen from this that Dr. Tan Shuilin is not bad in terms of diagnosis and prescription skills.
However, after three days of treatment, the patient not only did not improve significantly, but his blood urea nitrogen rose to 22mmol/l.
Dr. Tan Shuilin realized something was wrong and quickly sought help from his superior doctor.
There are still experts in the Department of Urology. After further diagnosis and examination of the patient, Director Zhang Zhongsheng of the Department of Urology immediately sought help from the Department of Nephrology.
Let’s talk about the two departments of nephrology and urology. One focuses on internal medicine and the other focuses on external medicine. In fact, they both diagnose and treat kidney diseases.
The difference is that the specialty of urology is to solve problems such as kidney stones and urinary stenosis through minimally invasive surgery.
Nephrology specializes in drug treatment.
In terms of diagnostic level, internal medicine is better. This is natural.
Because when treating with drugs, the cause of the disease must be clearly identified and the pathological mechanism must be clarified.
Urology is a bit rougher.
In most cases, it is found that the patient has stones or tumors, etc., and the problem is solved directly by surgery.
The chief physician of the Department of Nephrology came to the clinic and believed that the patient's renal edema and other lesions were probably just symptoms.
What does this mean?
That is to say, the cause of kidney enlargement is not the kidney itself, but other lesions that have not been identified.
This is what doctors fear most.
The symptoms were obvious and the lesions were extremely obvious. However, after treatment, it was found to be useless.
The real lesions are hidden in the dark and have not been detected.
When encountering such a case, it must be a difficult case.
In most cases, you need to find doctors from other departments for consultation.
For example, kidney enlargement may be caused by cardiovascular disease or liver disease. The organs of the human body are their own "cities", but they are directly or indirectly connected with each other, and they are very close.
To use the simplest analogy, if the heart stops beating, all the organs in the body will soon die along with it.
Because after the heart stops beating, blood circulation stops and all organs lose their 'energy' supply.
For another example, if there is a problem with the lungs and breathing stops, all the organs in the body will still be in trouble and die.
Because the lungs are important organs for blood oxygen exchange.
It stops working, which means the blood cannot get fresh oxygen.
The body can only shut down.
Therefore, every organ of the human body is extremely clever and closely related to each other. They are like the various parts of a precision instrument, maintaining the operation of the instrument.
The disease is as fierce as a tiger, progressing rapidly every minute.
Dr. Tan Shuilin is anxious. If this patient falls into his hands, will the hospital still allow him to sit in the clinic again?
And this is a human life!
He was anxious, and the director of the Department of Urology and his superior doctor, Director Zhang Zhongsheng, were equally anxious.
The department is a whole, and if something goes wrong, everyone will be unlucky.
In order to solve it as soon as possible, the director of urology department was in trouble.
Report to the medical department, and then report to the dean, who will organize the hospital's consultation. This option is tempting, but the price is also high.
The best way is to work it out privately.
It will definitely not work to push the patient out.
Therefore, the director of the Department of Urology and Director Zhang Zhongsheng began to use their personal connections to seek help from the chief doctors of some departments in the hospital.
There are many hidden causes that can cause renal edema.
Just a few big chunks.
Chief physicians in the Department of Cardiovascular Medicine, Department of Respiratory Medicine, and Department of Gastroenterology have all become targets for help.
Director Mu was invited over.
Let’s talk about Director Mu. Although he is more concerned about face, he is indeed a very kind person.
After consultation in the past, I felt that this patient might be caused by respiratory disease, but I was not sure. The chief physician, who is usually a bit cunning, would only mention it once.
However, Director Mu asked for the patient's information and said that he would bring it back to the department for the chief physician of the entire respiratory department to discuss it together.
Even though we are all colleagues in the same department, if you are at the level of chief physician, it is not so easy to recruit!
You said let everyone come together and discuss it?
is it possible?
People just say a few words, I have to attend an academic meeting tonight, or there is something important, I'm sorry, I just sent it away.
Director Mu could only chew this hard nut by himself.
He is not a patient in the Department of Internal Medicine, so maybe his colleagues will secretly scold him for being nosy.
Li Jingsheng could understand Director Mu's difficulties. He was sitting in the reception hall and silently analyzing the case alone.
Since the real cause is not renal failure and acute nephritis, what disease could it be?
The patient's symptoms are manifestations of renal failure and nephritis!
The urology department invited a cardiovascular physician for consultation and performed an additional echocardiogram on the patient.
It is suggested that there is slight thickening of the ventricular wall and interventricular septum.
Then a synchronized electrocardiogram was performed, which showed sinus tachycardia and normal ST-T.
Abdominal ultrasound examination results showed that the abdominal mass was enlarged kidneys, and the liver, gallbladder, pancreas, spleen and other organs were normal.
The patient had a chest X-ray, which showed some patchy shadows in the left lower lung.
The diagnostic conclusion tends to be that there is an infection in the lungs.
This is also the main reason why Director Mu took over this job.
At present, the patient has been given anti-infective treatment, and continues to receive diuretic, antihypertensive, antiemetic, analgesic, and Shenan injection treatments.
But the effect is not good.
Li Jingsheng's mind repeatedly replayed the patient information and various examination reports he had seen in Director Mu's office.
The Department of Urology now believes that the patient has polycystic kidney disease. In fact, judging from the B-ultrasound results, the possibility of polycystic kidney disease is very slim.
Polycystic kidney disease is generally congenital.
Severe polycystic kidney disease, according to the description in the book, can weigh more than 2.6kg.
Li Jingsheng believes that the possibility of polycystic kidney disease is very small. If the patient really has this disease, it should have developed long ago.
Is it idiopathic retroperitoneal fibroplasia?
He couldn't help but think of a disease with relatively high symptoms.
This disease, also known as vaginal periureteritis, is related to connective tissue lesions and is sometimes associated with infection.
Considering that the patient's chest X-ray showed a pulmonary infection, Li Jingsheng suspected this disease.
However, the mass in the patient's abdominal cavity has been determined to be both kidneys. There is no accumulation of water inside, and there are no abnormalities in serum protein and immunoglobulin, so the possibility of this disease is also very small.
Since the above two diseases have been ruled out, the only thing that can be thought of is probably primary renal tumor.
This disease will cause three combined symptoms: low back pain, abdominal mass, and hematuria.
Generally, men over forty years old are most likely to develop it.
To confirm the diagnosis, the patient must agree to a kidney biopsy.
Li Jingsheng decided to think from another angle. The patient reported pain in his right lower limb, which was actually a good breakthrough point.
Is it sciatica, or is it caused by compression of a lumbar tumor?
He believes that tumor compression may be more likely to cause it.
If possible, it is best to obtain an X-ray of the pelvis and anteroposterior and lateral X-rays of the lumbar spine.
In this way, it can be determined whether there are any pelvic lesions or the like.
Li Jingsheng felt a little thirsty and drank two large glasses of boiled water, just in time to relieve his hangover.
As for the argument that strong tea can relieve hangover, there is no scientific basis at all.
On the contrary, it may increase the burden on the liver and kidneys.
He was lying on the back of the chair, supporting the side of his face with one hand, still thinking hard about this female patient with enlarged kidneys and infected lungs.
Drowsily, he fell asleep sitting like this.
I worked in the hospital for a day, and after I came back, I organized a dinner party to entertain my colleagues in the old street in the south of the city. I was really tired.
After drinking a few glasses of wine, I felt extremely sleepy.
However, after a while, he was woken up by the ringing of his cell phone.
When I opened my eyes, I saw that I was still sitting in the reception hall. The lights were on and it was dark outside.
I glanced at the clock, it was eleven forty-two in the evening.
It's almost 12 o'clock in the evening. Who is calling him?
I took out my cell phone and saw an unfamiliar number.
"Hello, who are you looking for?"
"Dr. Li, it's me, I'm Qin Fei. Didn't you ask me to pay attention to the patient in bed 53 at night? I just measured his temperature. He really has a fever! 37.4 degrees, a low fever."
Dr. Qin must be quite depressed.
Li Jingsheng and he were colleagues in the same department, but his phone number was not saved.
Fortunately, he still took what Li Jingsheng told him to heart.
It’s so heartbreaking.
"Oh, it turns out to be Dr. Qin! What did you say? Does the male patient with lower body paralysis really have a low-grade fever at night?"
"Yes! I have measured it three times and I can confirm it."
Qin Fei was afraid that Li Jingsheng would suspect that he had no hair on his lips and was not reliable in his work, so he emphasized the measurement process.
"Thanks a lot!"
Li Jingsheng was quite excited when he heard the news.
"We are all colleagues in the same department. What Dr. Li said is a bit strange! I know that my diagnostic ability cannot be compared with yours. This difficult case is the key case of our department. Please pay more attention to it, Dr. Li."
Qin Fei has changed a lot!
Was he beaten by Director Hua? Then the consciousness increased?
After hanging up the phone, Li Jingsheng rubbed his temples. I still have to work at the clinic tomorrow, but none of the two difficult cases in the Second Hospital has been solved.
He walked to the bathroom and after urinating, he felt his bladder felt much better and his whole body felt relaxed.
I washed my face with cold water.
He decided to go to the inpatient ward of the Second Hospital to see the patient undergoing spinal canal repair surgery.
Obviously the lumbar spinal canal has healed and grown, so why is the patient still paralyzed in the lower body? If no obvious abnormality is found during neurological examination, what could be the problem?
The cause of the pain in the lower limbs of the female patient with enlarged kidneys was not found.
It's also possible that it's a neurological problem.
Go to the hospital and feel their bones, maybe you will find something new.
Li Jingsheng is more interested in studying difficult cases, but he has not yet reached the level of 'crazy'.
He is now willing to take a taxi there because he thinks that if the cause of the disease can be found, it will not only help the patient relieve pain and restore health, but even save two families.
Especially for the male patient, his girlfriend disliked him for being paralyzed and ran away.
Under the double blow, the possibility of committing suicide in despair is extremely high.
It was really difficult to get a taxi in the middle of the night. Li Jingsheng ran to the street outside the old street and waited for a long time before finally hailing a taxi.
There are two young female passengers on it, wearing smoky suits and wearing relatively hot clothes.
They seemed a little unhappy when they saw the taxi driver parking the car in front of Li Jingsheng.
Mainly in the middle of the night, and worried about meeting bad people.
In fact, if they dress up like this and haven't come home until midnight, they are probably not normal good-natured girls.
"Master, can I go to the second hospital?"
"Come on up! I'm just passing by and I'll give you a ride. You don't need to use the meter. You can pay me eight yuan, okay?"
"No problem! Thank you!"
Li Jingsheng got in the car.
"You two beauties, I'll charge you a few dollars less later. It's really hard to take a taxi late at night, so let this brother share a taxi."
"Fine!"
One of the beauties agreed.
Listening to this voice, he seems to be particularly young. She doesn't look like an aunt over thirty years old.
Dressed like this, young girls nowadays just know how to play.
Li Jingsheng was sitting in the passenger seat.
"You went to the hospital so late. Are you feeling uncomfortable?"
the driver asked him.
"I'm going to see the patient."
Li Jingsheng answered casually.
"Did any of your friends or relatives get an emergency and were sent to the hospital?"
"No, I'm a doctor there. A patient has a fever, so I rushed over to check on him."
Black lines appeared on Li Jingsheng's forehead.
This driver is quite enthusiastic, but he talks too much.
"Is it true or false? All of your doctors are usually very cold and don't care about the life or death of their patients. Ahem...I'm not talking about you, I'm just talking about some doctors."
"Watch your car!"
Li Jingsheng obviously didn't want to talk to the driver.
As his strength and status continued to increase, mainly due to the rapid increase in income, his mentality changed significantly when interacting with others.
I can’t really put it into words, but I’m just a little more calm and calm.
There is a balance in the card and there is money coming in every day, which gives him a little more confidence and courage to survive in this society.
(End of chapter)
